Provider Demographics
NPI:1962649947
Name:POWER PHYSICAL THERAPY & WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:POWER PHYSICAL THERAPY & WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDA
Authorized Official - Middle Name:GUERRA
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:956-206-8116
Mailing Address - Street 1:1219 CORPUS CHRISTI ST
Mailing Address - Street 2:STE A
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-5313
Mailing Address - Country:US
Mailing Address - Phone:956-206-8116
Mailing Address - Fax:
Practice Address - Street 1:1219 CORPUS CHRISTI ST
Practice Address - Street 2:STE A
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5313
Practice Address - Country:US
Practice Address - Phone:956-206-8116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1114338225100000X
TX2039675225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty